Chancroid treatment

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

The WHO and CDC recommended treatment regimens are shown in Table 77-5.37 There has been some debate about a suitable dosage of ciprofloxacin in the treatment of chancroid. Though the CDC recommends 500 mg orally three times daily, the WHO supports a single 500-mg oral dose. Ciprofloxacin has demonstrated an acceptable cure rate for a single dose (92%) when compared to erythromycin (91%). 

CDC-recommended treatment schedules for chancroid, gonorrhea, and acute PID-... 

Unlabeled Uses Treatment of bacterial endocarditis gonorrhea meningitis septicemia sinusitis and biliary tract, bone, joint, chancroid, chlamydial, intra-abdominal, skin, and soft tissue infections... 

Unlabeled Uses Systemic Treatment of acne vulgaris, chancroid, Campylobacter enteritis, gastroparesis, Lyme disease, diabetic gastroparesis Topical Treatment of minor bacterial skin infections... 

The spectrum of sexually transmitted diseases (STDs) includes the classic venereal diseases—gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale—as well as a variety of other pathogens known to he spread hy sexual contact (Table 46-1). Common clinical syndromes associated with STDs are listed in Table 46-2. The most current information on epidemiology, diagnosis, and treatment of STDs provided by the Centers for Disease Control and Prevention (CDC) can be found at http //www.cdc.gov. 

Blastomyces dermatitidis is highly endemic in river banks of most eastern states of North America, and there are worldwide reports of this infection including Africa, India and Europe, where its rare appearance is most probably related to contact with fomites. Skin lesions are a very common sign of chronic disease and appear as either pustules developing to ulcers or papules growing to verrucous lesions over months. African blastomycosis is characterized by bone infection and draining sinuses, traumatic implantation presenting as a chancroid-like lesion. Treatment amphotericin B is used for severe acute disease, otherwise ketoconazole, fluconazole or itraconazole have been effective. 

Belda Junior W, Siqueira LF, Fagundes LJ. Thiamphenicol in the treatment of chancroid. A study of 1,128 cases. Rev Inst Med Trop Sao Paulo 2000 42(3) 133-5. 

Enoxadn, USP. l-Ethyl-6-fluoro-l.4-dihydro-4-oxo-7-(I-piperazinyI)-I,8-naphthyridine-3-carboxylic acid (Pene-irex) is a quinolone with broad-spectrum antibacterial activity that is used primarily for the treaimenl of urinary tract infections and. sexually transmitted diseases. Enoxacin has been approved for the treatment of uncomplicated gonococcal urethritis and has also been shown to be effective in chancroid caused by Haemophilus ducreyi. A single 400-mg dose is used for these indications. Enoxacin is also approved for the treatment of acute (uncomplicated) and chronic (complicated) urinary tract infections. 

This chapter is a review of the antimicrobial susceptibilities of the causative organisms and the treatment of the sexually transmitted infections most prevalent in North America and Western Europe, gonorrhea, nongonococcal urethritis, genital herpes virus infections, and trichomoniasis. Because of their relative rarity or because no important advances in therapy have been made in the past decade, syphilis, lymphogranuloma venereum, chancroid, and granuloma inguinale are not considered. 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Tetracyclines are effective in the treatment of Rocky Mountain spotted fever, murine typhus, recrudescent epidemic typhus, scrub typhus, Q fever, lymphogranuloma venereum, psittacosis, tularemia, brucellosis, gonorrhea, certain urinary tract infections, granuloma inguinale, chancroid, syphilis, and disease due to Bacteroides and Clostridium. 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

It is effective against most coccus infections. It is better tolerated than sulfanilamide or sulfathiazole. In fact, it is as potent as sulfathiazole and possesses fewer side reactions. It has also been used in the treatment of chancroid due to Haemophilus ducreyi. It may also be used for the prophylaxis of recurrences of rheumatic fever. 

Sulfadiazine Competes with PABA (para amino benzoic acid) for incorporation into folate. When sulfonamide becomes incorporated, it inhibits enzymes (Fig. 7.14). Susceptibie bacteria rely on self-produced folate, while human cells are able to utilize exogenous foiate. Broad spectrum covers both Gram-positives and Gram-negatives. Infrequently used for treatment of uncomplicated urinary tract infections, nocardiasis, chancroid, prophylaxis against rheumatic fever. 

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